A 57-year-old woman was admitted to our unit suffering from
hemorrhagic shock and upper
abdominal pain. An enhanced computerized tomography (CT) scan evidenced a large retroperitoneal
hematoma due to visceral arteries
aneurysm rupture and a significant celiac axis root segmental
stenosis due to median arcuate ligament compression. A selective splanchnic arteries angiography showed 3 saccular pancreaticoduodenal artery arcade
aneurysm (PDAAs), 2 in the inferior posterior pancreaticoduodenal artery, and 1 smaller in the superior anterior pancreaticoduodenal artery. The largest
aneurysm showed evident
rupture signs. Both inferior PDAAs were successfully treated via endovascular coil embolization. The celiac trunk
stenosis and small inferior
PDAA did not require treatment. A CT scan control at 1-year follow-up did not reveal any new PDAAs. In cases of celiac artery trunk (CAT) steno-occlusive lesions, multiple
aneurysms can develop in the pancreaticoduodenal arcade. PDAAs should be treated because of high
rupture risk, regardless of diameter. Although endovascular treatment via coil embolization represents the treatment of choice nowadays, a simultaneous treatment of the associated CAT lesions is still debated. However, in cases of
aneurysm embolization alone, one cannot exclude that other PDAAs might develop in these patients in the future. Close monitoring and accurate long-term follow-up is highly recommended in these cases.